Original article
Vol. 140 No. 3536 (2010)
High prevalence of vitamin D deficiency in children and adolescents with type 1 diabetes
- M Janner
- P Ballinari
- PE Mullis
- CE Flück
Summary
Background: Vitamin D is important for bone health. An inadequate supply of vitamin D to the body is associated with a higher fracture risk in the elderly. Young adults with type 1 diabetes are reported to have a lower peak bone mass than healthy individuals, which could possibly lead to an increased fracture risk in the future. The prevalence of vitamin D deficiency in healthy young people is high. Thus, optimal supply of vitamin D may be of particular importance for bone health in children with type 1 diabetes.
Methods: In this prospective cross-sectional study we measured serum 25-hydroxy-vitamin D, iPTH, total and ionised calcium, phosphate, and alkaline phosphatase in 129 Swiss children and adolescents with type 1 diabetes.
Results: Of the 129 subjects 78 (60.5%) were vitamin D deficient, defined as a 25-hydroxy-vitamin-D level below 50 nmol/L. During the winter this number rose to 84.1%. 25-hydroxy-vitamin-D levels showed marked seasonal fluctuations, whereas there was no correlation with diabetes control. Despite the high prevalence of vitamin D deficiency, we found a low prevalence of secondary hyperparathyroidism in vitamin D deficient diabetic children and adolescents.
Conclusions:Prevalence of vitamin D deficiency in diabetic children and adolescents is high. Therefore, screening for vitamin D deficiency and supplementation in children with low vitamin D levels may be considered.
References
- Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.
- Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet. 1998;351:805–6.
- Baker MR, McDonnell H, Peacock M, Nordin BE. Plasma 25-hydroxy vitamin D concentrations in patients with fractures of the femoral neck. Br Med J. 1979;1:589.
- Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158:531–7.
- El-Hajj Fuleihan G, Nabulsi M, Choucair M, Salamoun M, Hajj Shahine C, Kizirian A, et al. Hypovitaminosis D in healthy schoolchildren. Pediatrics. 2001;107:E53.
- Tangpricha V, Pearce EN, Chen TC, Holick MF. Vitamin D insufficiency among free-living healthy young adults. Am J Med. 2002;112:659–62.
- Weng FL, Shults J, Leonard MB, Stallings VA, Zemel BS. Risk factors for low serum 25-hydroxyvitamin D concentrations in otherwise healthy children and adolescents. Am J Clin Nutr. 2007; 86:150–8.
- Specker BL, Ho ML, Oestreich A, Yin TA, Shui QM, Chen XC, et al. Prospective study of vitamin D supplementation and rickets in China. J Pediatr. 1992;120:733–9.
- Gordon CM, Feldman HA, Sinclair L, Williams AL, Kleinman PK, Perez-Rossello J, et al. Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med. 2008;162:505–12.
- Looker AC, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR. Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone. 2002;30:771–7.
- Lawson M, Thomas M. Vitamin D concentrations in Asian children aged 2 years living in England: population survey. BMJ. 1999;318:28.
- Guillemant J, Le HT, Maria A, Allemandou A, Peres G, Guillemant S. Wintertime vitamin D deficiency in male adolescents: effect on parathyroid function and response to vitamin D3 supplements. Osteoporos Int. 2001;12:875–9.
- Nicolaidou P, Hatzistamatiou Z, Papadopoulou A, Kaleyias J, Floropoulou E, Lagona E, et al. Low vitamin D status in mother-newborn pairs in Greece. Calcif Tissue Int. 2006;78:337–42.
- Pehlivan I, Hatun S, Aydogan M, Babaoglu K, Gokalp AS. Maternal vitamin D deficiency and vitamin D supplementation in healthy infants. Turk J Pediatr. 2003;45:315–20.
- Du X, Greenfield H, Fraser DR, Ge K, Trube A, Wang Y. Vitamin D deficiency and associated factors in adolescent girls in Beijing. Am J Clin Nutr. 2001;74:494–500.
- Lehtonen-Veromaa M, Mottonen T, Irjala K, Karkkainen M, Lamberg-Allardt C, Hakola P, et al. Vitamin D intake is low and hypovitaminosis D common in healthy 9- to 15-year-old Finnish girls. Eur J Clin Nutr. 1999;53:746–51.
- Outila TA, Karkkainen MU, Lamberg-Allardt CJ. Vitamin D status affects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm bone mineral density. Am J Clin Nutr. 2001;74:206–10.
- Ward LM, Gaboury I, Ladhani M, Zlotkin S. Vitamin D-deficiency rickets among children in Canada. CMAJ. 2007;177:161–6.
- Greer RM, Rogers MA, Bowling FG, Buntain HM, Harris M, Leong GM, et al. Australian children and adolescents with type 1 diabetes have low vitamin D levels. Med J Aust. 2007;187:59–60.
- Svoren BM, Volkening LK, Wood JR, Laffel LM. Significant vitamin D deficiency in youth with type 1 diabetes mellitus. J Pediatr. 2009;154:132–4.
- Pozzilli P, Manfrini S, Crino A, Picardi A, Leomanni C, Cherubini V, et al. Low levels of 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 in patients with newly diagnosed type 1 diabetes. Horm Metab Res. 2005;37:680–3.
- Gartner LM, Greer FR. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics. 2003;111:908–10.
- Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest. 2006;116:2062–72.
- Hollis BW. Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr. 2005;135:317–22.
- Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16:713–6.
- Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006; 81:353–73.
- Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998;338:777–83.
- Hofbauer LC, Brueck CC, Singh SK, Dobnig H. Osteoporosis in patients with diabetes mellitus. J Bone Miner Res. 2007;22:1317–28.
- Fogh-Andersen N, McNair P, Moller-Petersen J, Madsbad S. Lowered serum ionized calcium in insulin treated diabetic subjects. Scand J Clin Lab Invest Suppl. 1983;165:93–7.
- Saggese G, Federico G, Bertelloni S, Baroncelli GI, Calisti L. Hypomagnesemia and the parathyroid hormone-vitamin D endocrine system in children with insulin-dependent diabetes mellitus: effects of magnesium administration. J Pediatr. 1991;118:220–5.
- Schwarz P, Sorensen HA, Momsen G, Friis T, Transbol I, McNair P. Hypocalcemia and parathyroid hormone responsiveness in diabetes mellitus: a tri-sodium-citrate clamp study. Acta Endocrinol (Copenh). 1992;126:260–3.
- Association AD. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004;27:S5–10.
- Prader A, Largo RH, Molinari L, Issler C. Physical growth of Swiss children from birth to 20 years of age. Helvetica Paediatrica Acta. 1989;Suppl 52:1–125.
- Kromeyer-Hauschild K, Wabitsch M, Kunze D. Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschrift für Kinderheilkunde. 2001;149:807–18.
- Littorin B, Blom P, Scholin A, Arnqvist HJ, Blohme G, Bolinder J, et al. Lower levels of plasma 25-hydroxyvitamin D among young adults at diagnosis of autoimmune type 1 diabetes compared with control subjects: results from the nationwide Diabetes Incidence Study in Sweden (DISS). Diabetologia. 2006;49:2847–52.
- Ganong WF. Review of Medical Physiology. 20th Ed. Lange-McGraw Hill, New York, 2001.
- Conlin PR, Fajtova VT, Mortensen RM, LeBoff MS, Brown EM. Hysteresis in the relationship between serum ionized calcium and intact parathyroid hormone during recovery from induced hyper- and hypocalcemia in normal humans. J Clin Endocrinol Metab. 1989;69:593–9.
- NIH Consensus conference. Optimal calcium intake. NIH Consensus Development Panel on Optimal Calcium Intake. JAMA. 1994; 272:1942–8.
- Allgrove J. Calcium and Bone Disorders in Children and Adolescents. Karger Publ., Basel, 2009.
- Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84:18–28.
- Hintzpeter Birte CS-N, Manfred J. Müller, Liane Schenk and Gert B. M. Mensink. Higher Prevalence of Vitamin D Deficiency Is Associated with Immigrant Background among Children and Adolescents in Germany. J Nutr. 2008;138:1482–90.
- Ginty F CC, Michaud P-A, et al. Effects of usual nutrient intake and vitamin D status on markers of bone turnover in Swiss adolescents. Eur J Clinical Nutri. 2004;58:1257–65.
- Misra M PD, Petryk A, Ferrez Collett-Solberg P, Kappy M. Vitamin D Deficiency in Children and its Management: Review of Current Knowledge and Recommendations. Pediatrics. 2008;122:398–417.